Int J Thyroidol.  2021 May;14(1):55-59. 10.11106/ijt.2021.14.1.55.

Identification of Intrathyroidal Parathyroid Gland Using Near-Infrared Autofluorescence and Autotransplantation: Report of Two Cases

• Kim CH
• Seo YS
• Kim SW
• Lee KD

• KMID: 2516167
• DOI: http://doi.org/10.11106/ijt.2021.14.1.55

Abstract

For safe thyroidectomy, preservation of the parathyroid gland is mandatory. However, until recently, there has been no reliable method of identifying the parathyroid glands. Thus, the identification of the parathyroid gland has mainly depended on the surgeon’s personal experience. To overcome this limitation, near infrared autofluorescence (NIRAF) imaging technique has been introduced. Many reports support the claim that NIRAF imaging can help surgeons identify the parathyroid gland. However, there have been no reports on the feasibility of NIRAF imaging in detecting the intrathyroidal parathyroid glands that cannot be seen by the naked eye. Recently, we experienced two cases in which intrathyroidal parathyroid glands were identified and auto-transplanted with the use of NIRAF. We would like to share this experience and hope this paper helps thyroid surgeons identify the parathyroid gland more easily which is always a matter of concern.

Keyword

Parathyroid gland; Near infrared autofluorescence

Figure

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  Fig. 1 Diagrammatic feature of parathyroid imaging. (A) NIR device composed of light source, DSRL camera and LED display is useful to localize the parathyroid gland in real time under the background of surrounding structure. (B) When a specific wave length of light is illuminated, the parathyroid gland emits specific length of light, or autofluorescence, which is detected by a camera equipped with polarizing lens.

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  Fig. 2 Case 1: (A) Because right lower parathyroid gland was not found in a location where it usually would be, we scrutinized thyroid tissue to exclude possibility of embedded parathyroid beneath the thyroid capsule, or intrathyroidal parathyroid. (B) When we lighted the thyroid gland by near infrared light, we could find a bright, glowing parathyroid gland (arrow). (C) We carefully peeled the thyroid capsule, We found a parathyroid gland buried in the thyroid tissue (arrow) beneath the thyroid capsule. (D) The parathyroid gland is being carefully dissected while near infrared rays are being lighted.

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  Fig. 3 Case 2: (A) The left inferior parathyroid could not be found on naked eye, we plan to use NIR device for suspicious spot. (B) The tissue in the thyroid gland, which is white (arrow) when the NIR is illuminated, is indica-ted by the forcep. (C) The thyroid capsule is peeled off where the parathyroid is buried. (D) Parathyroid gland was exposed enough to be discernable by the naked eye.

Reference

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